Is universal HLA-B*15:02 screening a cost-effective option in an ethnically diverse population? A case study of Malaysia.
Br J Dermatol
; 177(4): 1102-1112, 2017 Oct.
Article
in En
| MEDLINE
| ID: mdl-28346659
ABSTRACT
BACKGROUND:
A strong association has been documented between HLA-B*1502 and carbamazepine-induced severe cutaneous adverse reactions (SCARs) in Asians. Human leucocyte antigen testing is potentially valuable in many countries to facilitate early recognition of patient susceptibility to SCARs.OBJECTIVES:
To determine the cost-effectiveness of universal HLA-B*1502 screening in preventing carbamazepine-induced Stevens-Johnson syndrome/toxic epidermal necrolysis in an ethnically diverse Malaysian population.METHODS:
A hybrid model of a decision tree and Markov model was developed to evaluate three strategies for treating newly diagnosed epilepsy among adults (i) carbamazepine initiation without HLA-B*1502 screening (current practice); (ii) universal HLA-B*1502 screening prior to carbamazepine initiation; and (iii) alternative treatment [sodium valproate (VPA)] prescribing without HLA-B*1502 screening. Base-case analysis and sensitivity analyses were performed over a lifetime time horizon. Incremental cost-effectiveness ratios were calculated.RESULTS:
Both universal HLA-B*1502 screening and VPA prescribing were dominated by current practice. Compared with current practice, universal HLA-B*1502 screening resulted in a loss of 0·0255 quality-adjusted life years (QALYs) at an additional cost of 707 U.S. dollars (USD); VPA prescribing resulted in a loss of 0·2622 QALYs at an additional cost of USD 4127, owing to estimated differences in antiepileptic treatment efficacy.CONCLUSIONS:
Universal HLA-B*1502 screening is unlikely to be a cost-effective intervention in Malaysia. However, with the emergence of an ethnically diverse population in many other countries, this may render HLA-B*1502 screening a viable intervention when an increasing proportion of the population is at risk and an equally effective yet safer antiepileptic drug is available.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Carbamazepine
/
Stevens-Johnson Syndrome
/
HLA-B15 Antigen
/
Anticonvulsants
Type of study:
Clinical_trials
/
Diagnostic_studies
/
Health_economic_evaluation
/
Prognostic_studies
/
Screening_studies
Aspects:
Patient_preference
Limits:
Adolescent
/
Adult
/
Humans
/
Middle aged
Country/Region as subject:
Asia
Language:
En
Journal:
Br J Dermatol
Year:
2017
Document type:
Article
Affiliation country:
Malaysia